MIRC TFS is designed to make authoring teaching file cases (and other imaging-focused educational materials) fast and convenient. The files you create can be as simple or elaborate as appropriate for their intended use. The instructions below cover the basic steps in the authoring process, while suggesting some of the flexibility possible in using TFS.

Once you've launched the Basic Author Tool, you'll see that it presents the outline of a teaching file case defined by an authoring template. By default, the template presented is the Basic Author Service Template, which includes a title, author information and a set of five sections with defined headings (Abstract, History, Findings, Diagnosis, Discussion).

The default initial title of a new case is the same as the template name. Change it to something that reflects the real subject so users can find the case once you have a fully developed library of cases).

Information you enter under "Add author and document owner information" will be used for the case you are currently authoring and as the default information for cases you author in future when logged into the site. (You can update the author information for your account by clicking on My Account at upper right.)

You can add as much text as you like to each section of the template and leave any section empty if you wish.

To add images to the case, click the Choose File button near the bottom of the page. You can browse to any images accessible to the computer you are using. (See below for instructions on getting images from a PACS into the authoring environment.) Repeat for each image you want to add. Note that TFS supports several common image formats, including jpegs and most kinds of DICOM images.

Once you have selected as many images as you want to include in this case, click the Submit button at the bottom of the page. TFS will launch the case you have been authoring. If you are using the Basic Author Service Template, it will look something like this:

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The sections you populated with text appear as tabs in the upper left pane and, by default, the file opens to the first in the sequence. Any sections you left blank will be missing. Note that the Document tab includes information about the case (including author, title and abstract) and controls you can use to share, edit and manage it.

The images you added to the case appear in the large right pane, in the sequence in which you added them. The controls at the top of the image pane let you flip through the images. Thumbnail "scout" images appear in the lower left pane.

You've mastered creating a new case with the basic authoring tool! Now on to sharing, editing and managing cases in your library …

When you create a new case, by default it is private—meaning only you can access it. By clicking the Publish button on the Document tab, you make it viewable by all users of your site.

You can set more specific access controls by using the Advanced Author Tool (see below). You can also create Conferences, which allow you to share a designated set of files with a group of TFS site users (see instructions for How to Set Up and Run Conferences).

You can make changes to a case (assuming you are logged in and have privileges to edit the case) using the controls on the Document tab. Clicking the Edit button will launch the Advanced Author Tool (see below). If you just want to add images to a case or sort the images in the case, there are buttons to launch simple pop-up screens to handle those functions.

You can make more extensive changes to the text, images or other attributes of an existing case by using the Advanced Author Tool.

When you are logged in to TFS you will see an Edit button the Document tab of any case you have privileges to modify.

Clicking the Edit button will launch the Advanced Author Tool. It provides a wealth of functions to add, modify or delete section tabs, text and images.

The section tab names available in the case you are editing are shown in a row of labeled boxes. Click on any one to add or modify text and add or remove images. There are special tabs where you can place Indexed Content, which TFS will use in searching for documents but won't display to other users, and PHI, patient-identifying information that will be visible only to the author.

The row of icons at the top of the window lets you add, delete or change the sequence of sections, paragraph text blocks, images, captions, patient information blocks, links to external Web pages, quiz questions and comments.

File Cabinet provides the palette of images you can use in creating and editing a case in the Advanced Author Tool. To add an image to any section, click to select the image in the File Cabinet (it shows a red frame when selected) and click the add images button in the toolbar (the one with the green icon).

To load images into your File Cabinet, navigate to it from the main TFS window. When you are logged in, a link to the File Cabinet appears in the left navigation bar. Note that on some sites you may have a choice of more than one File Cabinet to use. There are two file cabinets on most TFS sites: Personal and Shared. Images added to your personal file cabinet can only be viewed by you, while images added to the shared file cabinet are visible to other TFS users. Click the link to open the desired one.

The Add Folder button helps you organize the images in your File Cabinet.

Click the double up arrow to browse for and upload images. Choose the file you would like to add to the file cabinet by clicking on the "Choose File" button and selecting the file from your computer. Then click "Submit File" to add it to the file cabinet.

TFS can act as a DICOM receiver (SCP) so you can configure your PACS to send images directly to it. While the precise functionality varies from PACS to PACS, most current systems can be configured to send to alternate destinations. If you set up your TFS site as a destination, you can push image studies directly to it. While some PACS only allow you to send complete studies, others can be configured to send selected images (see, for example this MIRC Wiki article on configuring GE Centricity PACS to send selected images).

When you send images from PACS to TFS, they initially go into a case queue that only the logged in users of the site can see. While in that queue, the images retain patient identifying information so the author can find them. Multiple studies sent to TFS for a single patient will all be added to the same case. TFS even uses study acquisition date information from DICOM images to establish the time relationship of a patient's multiple studies. The initial study is set as the baseline and subsequent studies indicate how much later they were acquired (eg, "65 days later").

Once the author opens the case, edits and saves it, patient information is removed and the case is moved from the case queue to the author's cases (and shared with whomever the author selects).

Some PACS systems—notably Fuji Synapse and Candelis—can connect to TFS using a standard set of DICOM protocols specified in the IHE Teaching File and Clinical Trial Export (TCE) profile. This method allows you to specify key images from a study to include in a case and to add supplemental information at the time of export to make it easier to find the images and author the case. The example below is based on Fuji Synapse's implementation of TCE.

At your workstation, open one or more studies that you would like to use to create a teaching file. You can select entire studies or individual images within studies. To select individual images, go to the Overview tile format (Right-click › Tile Formats › Overview) and click on the desired images. Selected images display surrounded by a white box.

When you've selected the images and studies you wish to send, click on the DICOM transfer button in the main toolbar.

If you have selected individual images, you will see them in the list of selected items. If you select an entire study, you will see a single line for the study with item type Study Folder.

Scroll down, and select from the configured destinations, or enter the details for a new destination. In some Synapse systems, users cannot setup new Teaching Archives, but you should contact your system administrator if you wish to send to a MIRC TFS site not configured in your system.

In the Information for Manifest section, enter the details of the teaching file. There are only two required fields: title and archive user. Abstract and Additional Notes can be added if you think they will be helpful in creating the teaching file case.

In the Archive User field, enter the name you use to log into your MIRC TFS site.

If you want to fill in case details—including History, Findings, Discussion and Diagnosis—scroll down. Of course, you can always add or edit these on the RSNA TFS once the teaching file is created.

When you've added all the information you want to include, click Send. Sending may take a few minutes to complete, depending on the number of images you send and your network speed. When all the items are listed as completed, your case should be ready on the TFS site where you sent it. You can log in to view it, edit it, change access permissions—and all the other things TFS enables you to do with teaching file cases!

If there is no way to connect directly to a TFS site from their workstations, many radiologists save images for teaching files or presentations to removable media (such as a "thumb drive" or CD) and physically transfer them to a system where they can access TFS. This approach is inconvenient, hard to manage and prone to loss or exposure of information. However, if you are unable to persuade your IT administrator to connect to a TFS site via Patient-Centric Workflow or TCE, you can author cases using images stored on your local computer (or any accessible drive) using either the basic or advanced author tools as described above.